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What is Hextend
Hextend is used intravenously as a colloidal plasma volume expander. It has no oxygen-carrying capacity.
Hextend® produces increases in circulating blood volume that are comparable to that of albumin, dextran or Hespan®. Hetastarch has fewer antigenic properties than dextran.
Although Hespan® has been used clinically as an adjunct in the management or prevention of shock caused by hemorrhage, burns, surgery, or trauma; Hextend is currently only indicated in the treatment of hypovolemia during surgery. Hextend® contains 6% hetastarch, dextrose, normal physiological concentrations of sodium and calcium, and slightly lower than normal physiological levels of potassium and magnesium.
Lactate is included for buffering capacity.
Hetastarch is derived from a waxy starch composed almost entirely of amylopectin. Due to a structural similarity to glycogen, hetastarch has hydroxyl ethers introduced into its glucose residues to retard degradation by serum amylase. About 75% of the glucose units are hydroxyethylated.
The average molecular weight of hetastarch is approximately 670,000; at least 80% of the polymer units have a molecular weight between 20,000 and 2,500,000.
Hextend® was approved by the FDA on 3/31/99.
Indications
- hypovolemia
For use as a plasma expander in hypovolemia during surgery
NOTE: Hextend contains hetastarch, dextrose, and electrolytes. Hextend is not a substitute for blood or plasma.
Side Effects
- anaphylactoid reactions
- anemia
- angioedema
- bleeding
- bradycardia
- bronchospasm
- cardiac arrest
- chest pain (unspecified)
- chills
- clotting factor deficiency
- coagulopathy
- cough
- disseminated intravascular coagulation (DIC)
- dyspnea
- erythema multiforme
- fever
- flushing
- headache
- heart failure
- hemolysis
- hypotension
- intracranial bleeding
- metabolic acidosis
- myalgia
- nausea
- peripheral edema
- prolonged bleeding time
- pruritus
- pulmonary edema
- rash
- renal failure (unspecified)
- restlessness
- sinus tachycardia
- sneezing
- tachypnea
- urticaria
- ventricular fibrillation
- vomiting
- wheezing
Monitoring Parameters
- activated partial thromboplastin time (APTT)
- hemoglobin/hematocrit
- platelet count
- prothrombin time (PT)
- serum creatinine/BUN
- serum electrolytes
Contraindications
- anuria
- breast-feeding
- cardiac disease
- children
- coagulopathy
- corn hypersensitivity
- diabetes mellitus
- dialysis
- geriatric
- heart failure
- hepatic disease
- hydroxyethyl cellulose hypersensitivity
- hypercalcemia
- hyperkalemia
- intracranial bleeding
- lactic acidosis
- leukapheresis
- metabolic alkalosis
- mortality
- nephrotoxicity
- oliguria
- pancreatitis
- pregnancy
- pulmonary edema
- renal disease
- renal failure
- renal impairment
- respiratory alkalosis
- sepsis
- sodium restriction
- surgery
- thrombocytopenia
- von Willebrand’s disease
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Alendronate
- Alendronate; Cholecalciferol
- Aliskiren
- Aliskiren; Amlodipine
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Amlodipine; Benazepril
- Amlodipine; Celecoxib
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Ammonium Chloride
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Anticholinergics
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Atenolol
- Atenolol; Chlorthalidone
- Atracurium
- Atropine
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Atropine; Difenoxin
- Atropine; Diphenoxylate
- Atropine; Edrophonium
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- Azelastine; Fluticasone
- Azilsartan
- Azilsartan; Chlorthalidone
- Beclomethasone
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Belladonna; Opium
- Benazepril
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- Etodolac
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- Norfloxacin
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- Omeprazole; Sodium Bicarbonate
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- Phosphorated Carbohydrate Solution
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- Polycarbophil
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- Prednisolone
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- Pyridostigmine
- Quinapril
- Ramipril
- Rapacuronium
- Risedronate
- Rocuronium
- Rofecoxib
- Sacubitril; Valsartan
- Scopolamine
- Segesterone Acetate; Ethinyl Estradiol
- Sodium Bicarbonate
- Sodium Fluoride
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- Sodium Polystyrene Sulfonate
- Spironolactone
- Succinylcholine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulindac
- Tacrolimus
- Telmisartan
- Tetracyclines
- Thiazide diuretics
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- Tiludronate
- Tolmetin
- Trandolapril
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- Triamcinolone
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- Trientine
- Trihexyphenidyl
- Trimethoprim
- Tubocurarine
- Valdecoxib
- Valsartan
- Vecuronium
- Vitamin A
- Vitamin D
- Vitamin D analogs
